Diagnostic ultrasound ( PDFDrive )

CHAPTER 36 The Fetal Chest 1261
RT
LT
STOM
HRT
Bowel
HRT
DIAPH
A
B
C
D
FIG. 36.14 Right-Sided Congenital Diaphragmatic Hernia at 30 Weeks. (A) Axial and (B) and (C) oblique sagittal images show bilateral
pleural effusions (RT, LT) and bowel loops in the right hemithorax with mediastinal shift with heart (HRT) displaced to the left. The left hemidiaphragm
(DIAPH) is intact, with the stomach (STOM) below the diaphragm. (D) Coronal T2-weighted MRI shows luid extending from the abdomen into
the chest with mediastinal shift to left. Note the lack of a right hemidiaphragm, as well as bowel in the right chest. See also Video 36.6.
lung volume to fetal body volume (FLV/FBV) ratio, percent
liver herniation (%LH), and herniated liver to fetal thoracic
volume ratio (LiTR). 186,188 MRI can also measure the diameter
of the aorta and pulmonary arteries used to obtain the modiied
McGoon index as a prognostic indicator of pulmonary
hypertension. 189
Prognosis varies depending on the side of the herniation, the
position of the liver, associated abnormalities, and gestation age
at diagnosis. 190-196 he presence of a large amount of herniated
liver decreases survival substantially. 197 he severity of lung
hypoplasia and lung hypertension are major determinants in
mortality and morbidity rates. 31,198,199 A large hernia diagnosed
early in gestation results in relatively worse pulmonary hypoplasia
with a resulting higher mortality rate than does a small
hernia diagnosed late in gestation without associated indings.
Bilateral hernias are typically fatal. Familial and syndromic
hernias usually have a worse prognosis compared to isolated
hernias. 184,191-195